MEDICARE: LISANDRA PEREZ NODA RBT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician	RBT-24-324518	FL

General Provider Information

NPI Number	:	1881457802
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISANDRA PEREZ NODA RBT

Provider Business Mailing Address
First Line	:	13360 SW 52ND ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33175-5218
Country	:	US
Telephone Number	:	786-868-6363
Fax Number	:

Provider Business Practice Location Address
First Line	:	12150 SW 128TH CT STE 125
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33186-4672
Country	:	US
Telephone Number	:	305-964-5191
Fax Number	:	786-250-3038

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/01/2024
Last Update Date	:	04/02/2024

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